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Successful Reduction of a High Defibrillation Threshold by a Combined Implantation of a Subcutaneous Array and Azygos Vein Lead


  • There was no financial support for this study.

Takumi Yamada, M.D., Ph.D., Division of Cardiovascular Disease, University of Alabama at Birmingham, FOT 930E, 510 20th Street South, 1530 3rd AVE S, Birmingham, AL 35294-0019. Fax: +1-205-934-3950; e-mail:


A 72-year-old man with nonischemic cardiomyopathy was referred because his implantable cardioverter defibrillator had failed to terminate spontaneous ventricular fibrillation (VF). Defibrillation threshold (DFT) testing confirmed that 830-V shocks failed to defibrillate VF despite optimization of the biphasic waveform and reversal of shock polarity. The placement of a new right ventricular lead and the addition of a subcutaneous array failed to defibrillate VF at 830 V. The combination of a subcutaneous array and azygos vein coil successfully defibrillated VF. The mechanism for successful DFT reduction was likely greater current supplied to the posterior basal left ventricle by the azygos vein lead. (PACE 2012; 35:e173–e176)

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